Specialist consultants are often not available on nights or weekends in emergencies. Photograph: Shout/Rex

Six hundred lives a year could be saved if hospital services for those who suffer life-threatening injuries in accidents were better managed, the National Audit Office will say tomorrow.

Many accidents and injuries happen at night and weekends, often to young people, when emergency consultants are not often at work. Without rapid diagnosis and treatment, people suffer serious disabilities and lives are lost.

Edward Leigh, chairman of the public accounts committee, blamed the government. "For more than 20 years almost nothing has been done to remedy the lamentable provision of care for people suffering serious injuries, most commonly as a result of a road accident or fall," he said. "The Department of Health and NHS trusts were warned by the Royal College of Surgeons in 1988 and similar warnings have been repeatedly published since then but progress has been slight.

"The shocking truth is that an estimated 450 to 600 lives are being unnecessarily lost each year because of poor care."

Only one hospital in the entire country – the John Radcliffe in Oxford – has the necessary specialist consultant cover 24 hours a day, seven days a week, he said. That means people who have an accident outside of office hours are unlikely to be seen immediately by somebody who can decide what action has to be taken.

"This means that your chances of avoiding death or disability can turn on when your accident happens and to which hospital the ambulance takes you. Some hospitals have the appropriately trained surgeons for major trauma, many do not; and some areas have formal bypass arrangements for ambulances, but many do not.

"The situation could be worse than we think because two fifths of all hospitals with A&E departments do not provide statistics on how they deal with trauma patients. Major trauma services are currently provided in a disorganised and uncoordinated fashion. It cannot be beyond the capabilities of the Department and NHS trusts to establish a system, at little extra cost, enabling seriously injured patients to be delivered quickly to those parts of the health service best equipped to treat them."

The report found survival rates varied significantly between hospitals around the country, from five unexpected survivors to eight unexpected deaths per 1,000 patients.

"There is unacceptable variation, which means that if you are unlucky enough to have an accident at night or at the weekend, in many areas you are likely to receive worse quality of care and are more likely to die," said Amyas Morse, head of the NAO.

Dr John Heyworth, president of the College of Emergency Medicine, said the NAO report presented "a picture which we would recognise completely and we share these concerns. There has been a 20 year hiatus in trauma management and frankly that is unacceptable.

"We have known what the answers are for about 20 years but there has not been the commitment from various administrations in government and at a regional level to take this forward."

Major trauma centres need 16-18 consultants to proved 24/7 cover, he said. The average hospital currently has four, which is "self-evidently hopeless" and needs to be brought up to at least 10.

While the government has invested in extra scanners which can locate brain injury, they are often at a distance from the emergency department or not immediately available, he added.

The department of health said it was introducing regional trauma networks, as the report recommends, to allow patients to be delivered by ambulance to a specialised centre where teams of experts including neuro-surgeons could be available 24/7.

"We have twice the number of emergency consultants today as there were in 1997 and adult critical care capacity has increased by 54% in the last decade," said health minister Mike O'Brien. "Improving major trauma care is one of the key priorities for the NHS."